The Perception of Cancer Risk in Patients with Barrett's Esophagus

描述（由申请人提供）： 巴雷特食管（BE）被定义为食管中肠化生的发展，是一种容易发生食管腺癌的癌前病变。在不伴有不典型增生的 BE 情况下，癌症发病率较低，大约为 0.005 例/患者年。我们之前已经证明，BE 患者平均大大高估了他们患癌症的风险，并且高估的风险与资源利用率增加的趋势相关，例如内窥镜检查和门诊就诊。该应用程序的目标是：1) 在多中心研究中评估非发育性 BE 受试者的食管腺癌感知风险，2) 评估这些受试者的风险认知和资源利用之间的关系，3) 开发基于互联网的自我导向教学干预，以便在后续 RO1 应用中对 BE 受试者进行管理。研究人员是经验丰富的临床研究人员，在行为科学专家的协助下拥有长期的 BE 调查记录。该规划拨款将提供一种机制，以确认初步数据中有关巴雷特食管患者癌症风险高估的观察结果，并将检查风险认知与医疗保健利用之间的关联。它还将提供一种方法，在经过充分验证的医疗保健行为模型的框架内，开发旨在解决患者对风险的误解的干预措施。这笔赠款将允许完善疾病定义、结果测量、样本量和分析计划，并解决应用本赠款中开发的干预措施的后续多中心试验的可行性问题。由此产生的研究应用将评估与健康相关的生活质量、与健康相关的焦虑和医疗保健利用率作为结果。

DESCRIPTION (provided by applicant): Barrett's esophagus (BE), defined as the development of intestinal metaplasia in the esophagus, is a premalignant condition that predisposes to adenocarcinoma of the esophagus. The incidence of cancer in the setting of BE without dysplasia is low, approximating 0.005 cases/patient-year. We have previously demonstrated that patients with BE on average greatly overestimate their risk of development of cancer, and that over-estimation of risk was associated with a trend toward increased utilization of resources, such as endoscopy and clinic visits. The objectives of this application are: 1) to assess the perceived risk of esophageal adenocarcinoma in subjects with non-dysplastic BE in a multi-center study, 2) to assess the relationship between risk perception and the utilization of resources in these subjects, and, 3) to develop an internet-based based, self-directed teaching intervention to be administered to subjects with BE in a subsequent RO1 application. The investigators are experienced clinical researchers with a long record of investigation in BE, aided by experts in behavioral sciences. This planning grant would provide a mechanism to confirm observations from preliminary data regarding the overestimation of patients' cancer risk in the setting of Barrett's esophagus, and would examine the association between risk perception and healthcare utilization. It would also provide the means to develop an intervention designed to address patients' misunderstandings of risk, in the framework of a well-validated model of healthcare behavior. This grant will allow refining of disease definitions, outcome measures, sample size, and analysis plans and to address feasibility issues of a subsequent multi-center trial applying the intervention developed in this grant. The resultant study application will assess health-related quality of life, health-related anxiety and healthcare utilization as outcomes.